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Follow-Up Care for Children Prescribed ADHD Medication (ADD)

HEDIS Measure

Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Line of business: Commercial Medicaid

Data Collection Method: Administrative

Measure Description

The percentage of children newly prescribed attention- deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10- month period, one of which was within 30 days of when the first ADHD medication was dispensed.

Two rates are reported:

  • Initiation Phase. The percentage of members 6–12 years of age with a prescription dispensed for ADHD medication, who had one follow- up visit with a practitioner with prescribing authority during the 30-day Initiation Phase.
  • Continuation and Maintenance (C&M) Phase. The percentage of members 6– 12 years of age with a prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended

Numerator Compliance

Initiation Phase - A follow-up visit with a practitioner with prescribing authority, within 30 days after the IPSD.

Any of the following by a practitioner with prescribing authority meet criteria:

  • Outpatient, BH outpatient or observation visit, intensive outpatient encounter or partial hospitalization, community mental health center visit, telehealth or telephone visit.
  • Health and behavior assessment or intervention

Continuation and Maintenance Phase - At least two follow- up visits on different dates of service with any practitioner, from 31–300 days (9 months) after the IPSD.

Any of the following by a practitioner with prescribing authority meet criteria:

  • Outpatient, BH or observation visit, health and behavior assessment or intervention, intensive outpatient encounter or partial hospital or community mental health center visit
  • Telehealth, telephone, e-visit or virtual check-in

NOTE: Only one of the two visits (during days 31–300 after the IPSD) may be an e-visit or virtual check-in

IPSD - Index Prescription Start Date. The earliest prescription dispensing date for any statin medication of any intensity during the measurement year.

Best Practices

  • Discuss with patients the importance of taking medication as prescribed and remaining on the medication
  • Educate patients on possible side effects and the length of time it will take for the medication to have the desired effect.
  • Schedule at least three follow-up appointments within a 10- month period (e.g., 2-week, 6-week, 3- or 6-month appointments) before the patient leaves the office. First visit must be completed within 30 days of IPSD
  • Send appointment reminders to ensure the patient returns
  • Develop tracking method for patients who were prescribed or restarted ADHD medication
  • Require staff to follow up with patients who miss or cancel their appointment
  • Consider telemedicine appointments if in-person visits are not available
  • Consider the parent's work schedule as a barrier to the visit, and offer extended evening or weekend hours
  • Reference on Attention-Deficit/Hyperactivity Disorder: American Academy of Pediatrics, “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention- Deficit/Hyperactivity Disorder in Children and Adolescents” pediatrics
    aappublications.org/content/early/2011/10/14/peds.2011-2654

Quality Value Set Directory Coding Tips

BH Outpatient

CPT

  • 98960
  • 98961
  • 98962
  • 99078
  • 99201
  • 99202
  • 99203
  • 99204
  • 99205
  • 99211
  • 99212
  • 99213
  • 99214
  • 99215
  • 99241
  • 99242
  • 99243
  • 99244
  • 99245
  • 99341
  • 99342
  • 99343
  • 99344
  • 99345
  • 99347
  • 99348
  • 99349
  • 99350
  • 99381
  • 99382
  • 99383
  • 99384
  • 99385
  • 99386
  • 99387
  • 99391
  • 99392
  • 99393
  • 99394
  • 99395
  • 99396
  • 99397
  • 99401
  • 99402
  • 99403
  • 99404
  • 99411
  • 99412
  • 99483
  • 99492
  • 99493
  • 99494
  • 99510

HCPCS

  • G0155
  • G0176
  • G0177
  • G0409
  • G0463
  • G0512
  • H0002
  • H0004
  • H0031
  • H0034
  • H0036
  • H0037
  • H0039
  • H0040
  • H2000
  • H2010
  • H2011
  • H2013
  • H2014
  • H2015
  • H2016
  • H2017
  • H2018
  • H2019
  • H2020
  • T1015

SNOMED CT US Edition

  • 77406008
  • 84251009
  • 185463005
  • 185464004
  • 185465003
  • 281036007
  • 391223001
  • 391224007
  • 391225008
  • 391233009
  • 391237005
  • 391239008
  • 391242002
  • 391257009
  • 391260002
  • 391261003
  • 439740005
  • 3391000175108
  • 444971000124105

UBREV

  • 0510
  • 0513
  • 0515
  • 0516
  • 0517
  • 0519
  • 0520
  • 0521
  • 0522
  • 0523
  • 0526
  • 0527
  • 0528
  • 0529
  • 0900
  • 0902
  • 0903
  • 0904
  • 0911
  • 0914
  • 0915
  • 0916
  • 0917
  • 0919
  • 0982
  • 0983

Community Mental Health Center POS

POS

  • 53

Health and Behavior Assessment or Intervention

CPT

  • 96150
  • 96151
  • 96152
  • 96153
  • 96154
  • 96156
  • 96158
  • 96159
  • 96164
  • 96165
  • 96167
  • 96168
  • 96170
  • 96171

Observation

CPT

  • 99217
  • 99218
  • 99219
  • 99220

Online Assessments

CPT

  • 98969
  • 98970
  • 98971
  • 98972
  • 99421
  • 99422
  • 99423
  • 99444
  • 99457

HCPCS

  • G0071
  • G2010
  • G2012
  • G2061
  • G2062
  • G2063

Outpatient POS

POS

  • 03
  • 05
  • 07
  • 09
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 22
  • 33
  • 49
  • 50
  • 71
  • 72

Partial Hospitalization or Intensive Outpatient

HCPCS

  • G0410
  • G0411
  • H0035
  • H2001
  • H2012
  • S0201
  • S9480
  • S9484
  • S9485

SNOMED CT US Edition

  • 7133001
  • 305345009
  • 305346005
  • 305347001
  • 391038005
  • 391042008
  • 391043003
  • 391046006
  • 391047002
  • 391048007
  • 391054008
  • 391055009
  • 391056005
  • 391133003
  • 391150001
  • 391151002
  • 391152009
  • 391153004
  • 391170007
  • 391185001
  • 391186000
  • 391187009
  • 391188004
  • 391191004
  • 391192006
  • 391194007
  • 391195008
  • 391207001
  • 391208006
  • 391209003
  • 391210008
  • 391211007
  • 391228005
  • 391229002
  • 391232004
  • 391252003
  • 391254002
  • 391255001
  • 391256000

UBREV

  • 0905
  • 0907
  • 0912
  • 0913

Partial Hospitalization POS

POS

  • 52

Telehealth POS

POS

  • 02

Telephone Visits

CPT

  • 98966
  • 98967
  • 98968
  • 99441
  • 99442
  • 99443

SNOMED CT US Edition

  • 185317003
  • 314849005
  • 386472008
  • 386473003
  • 401267002

Visit Setting Unspecified

CPT

  • 90791
  • 90792
  • 90832
  • 90833
  • 90834
  • 90836
  • 90837
  • 90838
  • 90839
  • 90840
  • 90845
  • 90847
  • 90849
  • 90853
  • 90875
  • 90876
  • 99221
  • 99222
  • 99223
  • 99231
  • 99232
  • 99233
  • 99238
  • 99239
  • 99251
  • 99252
  • 99253
  • 99254
  • 99255